1. January - December 2013 Laurie Lee, RN, BSN, CCM FIMR Coordinator

2.  The FIMR Case Review Team meets 9x/year.  Review process developed by the American College of Obstetrics & Gynecology is used.  Information abstracted from birth, death, prenatal care, Healthy Start, WIC, hospital and autopsy records.  Efforts are also made to interview the family.  All information is de-identified.  Purpose is to determine specific medical, social, financial and other issues that may have impacted the poor birth outcome.  Recommendations for community action drafted annually based on findings. Prepared by Llee NEFL FIMR Healthy Start Coalition

3. The purpose of FIMR is to examine cases with the worst outcomes to identify gaps in services that might be addressed through community action. Cases selected for review based on specific criteria such as: Zip codes with high infant mortality rates Fetal losses over 36 weeks gestation or 2500 grams Deaths in outlying counties, etc. Prepared by Llee NEFL FIMR Healthy Start Coalition

5. Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats 141 infant deaths in 2013

6. Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats 68 white infant deaths in 2013

7. Prepared by L.Lee Source: Birth and Death Certificates/Vital Stats 65 black infant deaths in 2013

8. Infant DeathsBirthsIM Rate Baker13103112.6 Clay3162585.0 Duval305374138.2 Nassau1022544.4 St.Johns2356954.0 Prepared by Llee NEFL FIMR Healthy Start Coalition

10. *records may have more than one cause of death listed n=141

12. Northeast Florida Sleep related deaths

13. 20092010201120122013 #2216142125 % of deaths 15.1%12.6%12.9%16.5%17.7% Prepared by Llee NEFL FIMR Healthy Start Coalition

14. BakerClayDuvalNassauSt Johns # deaths 1 (Macclenny) 2 (Fleming Island and Middleburg) 1804 (3 different zips in St. Aug; 1- Hastings Duval county detail: In 2013, there were 18 deaths in 14 zips. No zip with > 2. Target area had 6.

15. Risk Factor Comparison 2008-2010 + 5 cases from 2011 Risk FactorN=70 Unsafe sleep surface80% Not on back to sleep63% Not in an infant bed70% Never breast fed63% Unsafe items in bed63% Second/third hand smoke 47% Sharing sleep surface63% Prepared by Llee NEFL FIMR Healthy Start Coalition

16. Maternal Findings Sleep Related Deaths-2013 84% single 60% in their 20’s; 24%-30’s; 16%-teens 60% black; all others white 64% inadequate prenatal care 12 % with no high school diploma 48% are overweight or obese; only 4 of these involved co-sleeping

17. Infant Findings Sleep Related Deaths-2013 All singletons except one twin 88% Medicaid 84% term 52% male

18. Prepared by L.Lee Source: Birth and Death Certificates/Vital stats 111 deaths:43-W; 62-B; 20-T

21. Birth CohortDeath Cohort: n=190 RaceW=56%; B=35%W=37%; B=58% AgeTeens trended down since 2007, currently about 7%; 20-29 year olds represent 55%; 30’s has steady increase over last 20 yrs, currently at 35%; 40+ varies, but overall, increase in last 20 years, currently at 3% Slightly higher % of teens (8.6%) and 20’s (58%); slightly lower 30’s and 40’s (32% and <1 %, respectively). Single Marital Status 48% last 5 yearsHad decreased from 65% to 57% last 5 years; now 70% No HS Diploma 13.8% Was about 30%, now at 16.2%

22. Birth CohortDeath Cohort Smoking6.9%Was trending down 17 – 12% over last 4 yrs; now 15% Overweight/Obese BMI 50.3%42.8% (plus 8% underweight) Inadequate prenatal care28.2%Was trending down over last 5 yrs-40 to 33%; now at 36% Pregnancy Interval < 12 mos State tracks < 18 mos; now 39.5% Was trending down 22-14% last 6 years; now 20%

23. 79% all FIMR cases had medical history issues

24. Prepared by L.Lee Source: FIMR/CRT case reviews

27. Contributing Factors in FIMR Cases 2011-2013 N=81 Prepared by L.Lee Source: FIMR/CRT case reviews

28. Contributing Factors in FIMR Cases 2011-2013 N=81 Prepared by L.Lee Source: FIMR/CRT case reviews

29. Contributing Factors in FIMR Cases 2011-2013 N=81 Prepared by L.Lee Source: FIMR/CRT case reviews

30. Continue to focus on preventing sleep related deaths. The number of sleep related deaths has increased over the last 3 years. The number of deaths for years 2011, 2012 and 2013 were 14, 21 and 25 respectively. When compared to all causes of death in infants for years 2011, 2012 and 2013, this represents 13%, 16.5%, and 18%, respectively. Education should focus on babies sleeping alone on a safe sleep surface.

31. The following are potential partners: Healthy Mothers Healthy Babies to revive the Cribs 4 Kids programs Americorp Faith based organizations for “Safe Sleep Sundays” Make a Noise, Make a Difference Curriculum for health advisors Baptist Community Health Video link Safe Kids Coalition National SIDS Foundation Free educational materials WIC Include safe sleep in breast feeding courses CDC Video to use in educational settings City Match LifeCourse board game The Players Center For Child Health at Wolfson Children’s Hospital- Ready, Set Sleep program

32.  Continue to focus on dangers of smoking during pregnancy. ◦ The Community Action Team’s “Don’t Blow Smoke” campaign is gaining momentum.  Phase I (target area-Health Zone 1)  Phase 2 (social media and expansion outside the target area to include the 32218 and 32244 zip codes) have been implemented. ◦ The percentage of moms in the death cohort that self-reported tobacco use was 12% in 2012. It rose to 15% in 2013. Self-reported tobacco use in the 2013 birth cohort is 6.9%.

33.  Any questions?